Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, Massachusetts, USA.
Am J Sports Med. 2022 Mar;50(3):834-844. doi: 10.1177/0363546521993807. Epub 2021 Mar 15.
While some studies have failed to reveal any significant relationship between magnetic resonance imaging (MRI) grading and return to sports after bone stress injuries, others have reported either a linear or nonlinear relationship.
To evaluate the prognostic value of MRI grading for time to return to sports and rate of return to sports after bone stress injuries.
Systematic review and meta-analysis.
A systematic search was performed in PubMed, Web of Science, SPORTDiscus, and Google Scholar. Studies reporting return to sports data after bone stress injuries using MRI grading systems were included in this review. The risk of bias was evaluated using the Quality in Prognosis Studies tool. Meta-analyses were performed to summarize the mean time to return to sports. The Pearson correlation was used to determine the relationship between time to return to sports and MRI grade. A meta-analysis of proportions was conducted to determine the percentage of athletes who successfully returned to sports.
A total of 16 studies with 560 bone stress injuries met inclusion criteria. Higher MRI-based grading was associated with an increased time to return to sports ( < .00001). Pooled data revealed that higher MRI-based grading correlated with a longer time to return to sports ( = 0.554; = .001). Combining all anatomic locations, the mean time to return to sports was 41.7 days (95% CI, 30.6-52.9), 70.1 days (95% CI, 46.9-93.3), 84.3 days (95% CI, 59.6-109.1), and 98.5 days (95% CI, 85.5-112.6) for grade 1, 2, 3, and 4 injuries, respectively. Trabecular-rich sites of injury (eg, pelvis, femoral neck, and calcaneus) took longer to heal than cortical-rich sites of injury (eg, tibia, metatarsal, and other long-bone sites of injury). Overall, more than 90% of all athletes successfully returned to sports.
The findings from this systematic review indicate that MRI grading may offer a prognostic value for time to return to sports after the nonsurgical treatment of bone stress injuries. Both MRI grade and location of injury suggest that individually adapted rehabilitation regimens and therapeutic decisions are required to optimize healing and a safe return to sports.
虽然一些研究未能显示磁共振成像（MRI）分级与骨应力损伤后重返运动之间存在任何显著关系，但其他研究报告了线性或非线性关系。
评估 MRI 分级对骨应力损伤后重返运动时间和重返运动率的预测价值。
系统评价和荟萃分析。
在 PubMed、Web of Science、SPORTDiscus 和 Google Scholar 中进行系统检索。本综述纳入了使用 MRI 分级系统报告骨应力损伤后重返运动数据的研究。使用预后研究质量工具评估偏倚风险。进行荟萃分析以总结重返运动的平均时间。使用 Pearson 相关系数确定重返运动时间与 MRI 分级之间的关系。进行荟萃分析以确定成功重返运动的运动员百分比。
共有 16 项研究，560 例骨应力损伤符合纳入标准。更高的基于 MRI 的分级与重返运动时间延长相关（<.00001）。汇总数据显示，更高的基于 MRI 的分级与更长的重返运动时间相关（= 0.554；=.001）。结合所有解剖部位，重返运动的平均时间为 41.7 天（95%CI，30.6-52.9）、70.1 天（95%CI，46.9-93.3）、84.3 天（95%CI，59.6-109.1）和 98.5 天（95%CI，85.5-112.6），分别为 1 级、2 级、3 级和 4 级损伤。富含小梁的损伤部位（例如骨盆、股骨颈和跟骨）比富含皮质的损伤部位（例如胫骨、跖骨和其他长骨损伤部位）愈合时间更长。总体而言，超过 90%的运动员成功重返运动。
本系统评价的结果表明，MRI 分级可能对骨应力损伤非手术治疗后重返运动时间提供预测价值。MRI 分级和损伤部位均表明，需要个体化的康复方案和治疗决策，以优化愈合和安全重返运动。
